Imagine you are facing the following situations. You want to say something in a respected publication about a conflict between the health ministry and private hospitals over reimbursement. You wish to discuss matters that touch local sensitivities, such as mismanagement of health programmes, but you expect blame for showing “dirty laundry” internationally. You publish commentaries about local issues in “high impact” journals but discover that only a few of your local colleagues have read them. You have researched a locally relevant topic that may not interest overseas readers and hope to publish the results locally. What are the appropriate platforms for publishing each of these types of article? You might think that local or regional journals will fulfil the need, but this would be wishful thinking today in many developing countries.

Why can't we upgrade our journals?

Let's take representative examples from my region: the Lebanese Medical …